Health Insurance

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Millions of Americans have periods during which they have no health insurance. For example, 19 percent of the U.S. population lacked insurance for all of 1994. According to a recent study supported by the Agency for Healthcare Research and Quality (HS10283), being uninsured for just 2 years adversely affects the health of adults in late middle age. David Baker, M.D., M.P.H., and his colleagues at Case Western Reserve University used 1992, 1994, and 1996 Health and Retirement Study data files for community-dwelling U.S. adults who were 51 to 61 years of age in 1992.

They examined major declines in self-reported health (from good or excellent to fair or poor, or from fair to poor) and functioning (indicated by a new mobility difficulty, for example, in walking one or more blocks or being able to climb stairs without resting) for those with private health insurance in 1992 (7,222 adults) who became uninsured in 1994. At the time of the 1994 interview, 5,768 people (95 percent) continued to have private insurance, 3.8 percent no longer had any form of insurance, and a little more than 1.2 percent converted to having only public insurance. By 1996, those who lost all insurance had a 15.6 percent risk for a major decline in overall health compared with 7.2 percent for those with continuous private insurance.

After adjustment for sociodemographic characteristics, health behaviors, and health status, those who had lost coverage had nearly double the relative risk for a major decline in health (adjusted relative risk, ARR 1.82). Those who became uninsured in 1994 were at increased risk for a major decline in health even if they had regained private insurance by the 1996 interview (ARR 1.59). For those who were uninsured in 1994 and remained uninsured in 1996, the adjusted relative risk was even higher at 2.07.

More details are in "Loss of health insurance and the risk for a decline in self-reported health and physical functioning," by Dr. Baker, Joseph J. Sudano, Ph.D., Jeffrey M. Albert, Ph.D., and others, in the November 2002 Medical Care 40(11), pp. 1126-1131.